1 2 3 4 5 6 7 Teen Suicide Kevin McFarlane BSN,RN,CEN,EMT University of New Mexico Hospital Suicide The spectrum of suicide Suicide Defined Suicide: Intentionally causing one s own death. Sometimes difficult to determine intention High speed, 1 car accidents Auto-erotic hangings Reluctance to label as suicide because of stigma What is most popular place to commit suicide in the United States? Suicide Rates by States and Washington, DC (2004) Suicide Statistics Emergency room visits for self-inflicted injury: 400,000 Average number of deaths each year 30,622 On average, a young person (age 15-24) dies by suicide every 2 hours and 12 minutes. 8 9 79.4% Gender Disparities Firearms are the most commonly used method of suicide among males (57.6%) Poisoning is the most common method of suicide for females (39.1%) www.krksouthwest.com 1
10 11 Racial and Ethnic Disparities Among American Indians/Alaska Natives ages 15- to 34-years, suicide is the second leading cause of death. Attempts Percentage of suicide attempts Female high school students in grades 9-12 14.0% Hispanic 7.7% White, non-hispanic 9.9 Black, non-hispanic 12 Nonfatal Suicidal Thoughts and Behavior 15-24 y/o 1:100-200 suicide to attempts 13 2007 YRBSS Grade 6-12 Youth Risk Behavior Surveillance System 14 2007 YRBSS Grade 6-12 Suicide Drinking Fighting Obesity Physical activity Smoking Drug use Drinking and driving Resiliency Factors Parents in the home Caring relationships with adults and peers www.krksouthwest.com 2
Caring relationships with adults and peers 15 16 17 18 1 1 14.5% 6.9% Theories explaining teen suicide Psychological factors Biochemical Genetic link Complicating Factors Explanations for Suicide Psychological They become angry at loss and turn their anger inward. 19 20 Psychological factors Loss of a loved one Overwhelming rage or guilt Copycat suicide / Suicide clusters Biochemical Low level serotonin associated with suicide completion Serotonin is a neurotransmitter, which helps regulate sleep, memory, aggressive behavior, and other functions. 21 22 Genetic link Hemingway family Earnest Hemingway Father Both siblings Granddaughter Genetic link 12% of attempters' children attempted suicide www.krksouthwest.com 3
12% of attempters' children attempted suicide 2% of non-attempters' children attempted suicide. 23 Genetic link Adoption studies: a greater risk of suicide among biologic rather than adoptive relatives. Suicide appears to be an independent, inheritable risk factor. 24 Complicating Factors Family history of abuse, violence place individuals at increased risk for suicidal behaviors Histories of childhood physical abuse and sexual abuse, as well as parental neglect and separations, may be correlated with a variety of self-destructive behaviors. 25 Complicating Factors Drug and alcohol abuse 30 and 50 % of persons who die by suicide have a dependence on alcohol or drugs 26 27 Teen Suicide and Psychiatric Illness Depressive disorders Schizophrenia Alcohol or substance abuse Anxiety Disorders Personality disorders Drug and Alcohol Abuse In completed suicides, men have higher rates of alcohol abuse, women have higher rates of drug abuse Increased number of substances used, rather than the type of substance appears to be important Most have co-morbid psychiatric disorders, www.krksouthwest.com 4
Most have co-morbid psychiatric disorders, females have Borderline Personality Disorder Highest Risk: Recent or impending interpersonal loss Co-morbid depression 28 29 30 31 Teen Suicide Methods Firearms Hanging Strangulation Suffocation Poisons Hard methods Gun Hanging Soft methods Slashing wrists Overdose on pills Warning Signs Change in eating and sleeping habits Withdrawal from friends, family, and activities Unusual violent actions or rebellious behavior Unusual neglect of personal appearance Marked personality change Loss of interest in pleasurable activities 32 SADPERSONS Scale Sex Age Depression Previous Attempts www.krksouthwest.com 5
Previous Attempts ETOH (alcohol use) Rational thinking loss Social Supports lacking Organized plan No spouse Sickness 33 34 35 Interviewing a Suicidal Teen Lethality of the plan Means to carry out plan Suicide Evaluation Assessment Anxiety Irritation Avoidance Denial Direct Questioning About Suicide Ask About: Suicidal ideation Suicide plans 36 Direct Questioning About Suicide Give Added Consideration to: Suicide attempts (actual and aborted) First episode of suicidality (Kessler 1999) Hopelessness Ambivalence: a chance to intervene Psychological pain history 37 Components of Suicidal Ideation Intent: Subjective expectation and desire for a self-destructive act to end in death. www.krksouthwest.com 6
Subjective expectation and desire for a self-destructive act to end in death. Lethality: Objective danger to life associated with a suicide method or action. 38 Assess Degree of ambivalence - wish to live, wish to die Intensity, frequency of attempt Rehearsal/availability of method Presence/absence of suicide note Deterrents (e.g. family, religion, positive therapeutic relationship, positive support system - including work) 39 Characteristics of a Suicide Plan Method Time Place Available means Arranging sequence of events 40 41 Interviewing a Suicidal Teen Questions for the parent include asking about issues related to: Home Drugs Sexual activity School and peers changes in these Changes in grades Friendships Breakups, Preoccupation with death Questions to Ask how things are going? www.krksouthwest.com 7
how things are going? 42 43 44 45 46 47 Questions to Ask How are things at school? Do you enjoy your studies or are they stressful? What are your future plans? Do you have friends that you can talk to when things are tough? Have you recently lost a good friendship or close relationship? Questions to Ask Do you feel like others do not like you? Do you spend a lot of time alone Is there an adult (other than parents) to whom you can confide your fears/worries/concerns Have you used any medications/drugs that were not for a specific illness or condition Questions to Ask Are you sexually active if so, what protection are you using for pregnancy and STD does your parent know you are having sex (a surprising number do know and have taken kids for birth control counseling, etc) If a girl, ask if she could be pregnant Have you ever considered suicide? If so, what method would you use and do you have access to it? Keeping them safe Psychiatric evaluation Treatment options Treat at home with follow up care Hospitalization Suicide effect on the family Every 19 minutes someone commits suicide www.krksouthwest.com 8